Oral Health in the
Gestational Period
The oral health of women during pregnancy can and should be accompanied with
proper treatment and safety for mother and baby.
Chapters
1. Preventive Aspects
a. Nutrition
b. Oral Hygiene
Page 1

A pregnant woman can and should take
care of their oral conditions in order to
stay healthy and preserve the health of
your baby

!
Hypoglycemia is frequently
associated to pregnancy. The
demands of carbohydrates by the
fetus may be increased so that there
is a drop in the sugar levels in the
mother’s blood. (Hypoglycemia means
low level of glucose in blood. When
glycemia is below 60 mg, symptoms of a
hypoglycemic reaction may occur. This
varies among individuals. There is an

Pregnancy causes fatigue in
the
carbohydrate
metabolism.
Insulin demands in the pregnant
woman are increased and may
transform subclinical asymptomatic
Diabetes Mellitus into clinical
diabetes. (Gestational diabetes is the
alteration of sugar index in blood that
starts or is detected for the first time in
pregnancy. It may persist or disappear
after delivery. There are several criteria
to
diagnose
GDM,
but
the
recommendation is to use that from the
World
Health
Organization
(WHO).www.diabetes.org.br/diabetes/
hipog.php in Jul 2012). Wikipedia in
Nov 2007.).

6. References and
Credits

acute hunger sensation, difficulty to
think, weakness with extreme tiredness,
pronounced sweating, fine or rough
extremity
trembling,
yawning,
sleepiness, double vision, confusion that
may lead to unconsciousness, that is,
coma. It is important friends and
relatives know the person is using
insulin or oral hypoglycemic drug. This
way, they can diagnose hypoglycemia.
www.diabetes.org.br/diabetes/hipog.php
in Jul 2012).
Morning sickness is attributed to a
rise in chorionic gonadotropin and
hypoglycemia. The recommendation
is to eat several meals a day – at
least 6: breakfast, morning snack,
lunch, afternoon snack, dinner and
supper. (Barbosa CP, 2003 - human
chorionic gonadotropin (hCG) is a
hormonal glycoprotein produced by the
placenta. In the beginning of pregnancy
the hCG concentrations in the woman’s
serum and urine increase rapidly and
this is a good marker in pregnancy
1

S

A

Ú

D

E

B

U

C

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N

A

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T

A

Ç

Ã

O

tests. Seven to ten days

clean parts of the floss in a new

after conception, the hCG

cleaning.

concentration reaches 25
mUI/mL and increases to a peak of

!

37.000-50.000 mUI/mL between eight

use a soft bristle toothbrush (hard

and eleven weeks. It is the only hormone

bristles may cause gingival bruises

exclusive to pregnancy, providing for a
correct hCG analysis in almost 100%. It
is the only test that confirms pregnancy
exactly. Wikipedia in Jul 2012).

b. Oral Hygiene

Figure 1 – holding the dental floss

For brushing it is necessary to

and do not penetrate the spaces to be

After this, thumbs and index efficiently cleaned) with a small head
fingers help to introduce the dental (to brush tooth by tooth efficiently)
floss between teeth (in the and round handle to prevent
embrasures) taking it below the

accidents.
gingival limit (fig. 2) and rubbing the
During this period there is an increase lateral parts (proximal aspects) of !
The
dentifrice
can
be
in blood supply on the mucosa that each tooth to be cleaned.
eliminated if it means a high cost to
should not be mistaken for gingival
the patients, according to their
edema.
financial possibilities; if possible,
Oral hygiene must be complete
instruct them to choose a fluoride
including the use of dental floss besides
dentifrice and apply a small part on
brushing after every meal plus morning
and evening hygiene. It is interesting to

the toothbrush before introducing it

remember that the quality of oral

into the oral cavity.

hygiene characterizes the cases prone to
periodontal disease.

!

individual

If the pregnant woman cannot stand the

toothbrushes

and

members of one family that share the

use of dentifrice that may cause nausea,

same

she can clean only with the toothbrush,
dental floss and mouth rinse.

Populations that cannot buy

Figure 2 – how to use the dental floss

toothbrush

should

be

instructed to clean it with common

It is important to follow a

bleaching products to be reused by
sequence
so
that
no
teeth
is
missed
of floss should be removed from
other members of the family.
package (raffia thread can be used: in this procedure; example: start by
It is necessary to establish a
the same material used in Hawaiian the central incisor and go to the right
procedure to use the toothbrush:
Carnival skirts. Reel off the raffia
up to the last molar, go back to the
start by right upper molars and go
strip forming thin threads and use as
central
incisor
and
follow
to
the
left
described below).
up to the left upper molars. Adopt
up to the last molar. The same
the same criteria to the lower teeth.
!
The floss should be caught on
the middle fingers of both hands procedure should be done in the The bristles must be positioned at
leaving index fingers and thumbs lower teeth.
45º with the palatal or lingual and
free to move the floss between teeth !
At each cleaned embrasure
buccal aspects to be brushed turned
(fig. 1).
the floss should be rolled up on the
to the gingival groove. They should
Illustrations – obtained Sept 2012 in: middle fingers to release and use
vibrate in short movements from
www.pgr.mpf.gov.br/pgr/saude/
!

performed by brushing the upper diastolic arterial pressure. Wikipedia in
aspect with the toothbrush.

Jul 2012.
!
!

2. Healing Aspects –
Treatment of oral
problems

content in the aorta, the energy is the
greatest, generating maximum force
and,

a. Phisiological alterations in
the period
!

The moment the heart ejects its

as

a

consequence,

maximum

pressure. This phase in the cardiac cycle
is called systole and the pressure in this

During pregnancy there is an moment

is

called

systolic

arterial

increase of 10 heartbeats/minute in pressure).
the cardiac rate from the 14th. up to !
the 30th. week. The arterial blood !

Hypertension in pregnancy

pressure is stable up to the 30th. occurs when the systolic arterial
Figure 3 – position of toothbrush bristles
to clean the smooth aspects of teeth
(lingual or palatal and buccal)

!

The occlusal surfaces should

be brushed with the toothbrush

week when the diastolic arterial pressure is higher than 140mmHg
pressure (low) may slightly decrease and

the

diastolic

higher

than

and the systolic (high) may slightly 90mmHg in two measurements at
increase

(Arterial

pressure

is

the rest with an interval of 4h or when

parallel to the long axis of the tooth,

pressure exerted by the blood against the there is an increase greater than

vibrating from distal to mesial (fig.

internal surface of the arteries. The 30mmHg in the diastolic compared

4).

original force comes from the heartbeat. to the normal values previous to
The arterial pressure varies at each pregnancy (Silva et al. 2006).
moment following a cyclic pattern. The The vital respiratory capacity is
various cycles overlap but the most increased leading to a larger oxygen
visible is the one determined by cardiac consumption
beats.

and

increase

in

Cardiac cycle is the group of respiratory rate.

situations from one cardiac beat up to !
the next beat. Wikipedia in Jul 2012.
Figure 4 – position of the toothbrush to
brush the occlusal aspects

!

More attention should be

given to the distal of upper and
lower last molars and the lingual of
lower incisors.
!

The tongue must be also

!

!

The

Immediately before the next metabolism

alteration
of

in

the

carbohydrates

heartbeat, the energy is very little and demands changes in eating habits
the least force is exerted on the arteries and more meals are recommended,
in the whole cycle, generating the lowest putting at risk the dental health if
arterial pressure of the cardiac cycle. eating is not followed by quality
This phase is called diastole and the hygiene. Read the text about Oral
pressure in this moment is called Hygiene (link in the text) (Barbosa

cleaned and this procedure can be
UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

CP, 2003).
3

O

R

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A

L

T

H

I

Appointments

b.The best moment
for dental treatment

scheduled

N

P

should

not

be metabolism) and new applications

dentist

or may stress the patient and increase

when

the

R

E

assistant have flu or cold.

G

N

A

N

C

Y

the toxic potential in the body (An

The best moment for dental The maximum amount of anesthetic agent (generally a substance) that
treatment is between the 4th. and should not exceed two cartridges of narrows the blood vessel lumen
!

6th. month of pregnancy, avoiding a 2% lidocaine solution per reducing absorption capacity. Digital
the periods that are considered appointment, avoiding the risk of Dictionary of Medical Terms in
adverse reactions and toxicity to the www.pdamed.com.br in Jul 2012).

critical by the physicians.

mother

and

fetus

(Lidocaine

or !

If the woman has instructions

Xylocaine® is a class I antiarrhythmic from the physician who follows her

Schedule and duration of
appointments and anesthetic drug (subgroup 1B) and the local neonatal about the use of anesthetics
dosage used during the dental anesthetic that is used in the treatment without
vasoconstrictors
or
procedure
of cardiac arrhythmia and local pain (as anesthetic agents, get in contact with

!

Appointments

should

be in surgeries). Low toxicity. Wikipedia in the doctor to explain the nature of

short, preferably in the second half Nov 2012).

the oral intervention and the amount

of the morning when sickness is less

of anesthetics to be applied in each

common. Appointments should also

The
amount
of
Can the baby be affected by treatment.
be scheduled in different hours from the mother’s lack of oral care? vasoconstrictor is minimal and if
those of the children who visit the

Yes! Not only is the mother’s stress is controlled during treatment,
clinic, preventing possible viral
health in danger but also the baby’s. no discomforts will occur to the
infections common in childhood
Oral infection in the tooth, tongue, patient and the baby.
!

(rubella, measles, etc.) (Barbosa CP,

gingiva and/or mucosa must be If the doctor insists on the use of
2003 - Rubella is a disease caused by the
treated as soon as possible. These anesthetics without vasoconstrictors,
rubella virus that is transmitted by the

may lead to several health problems ask a written recommendation and
airways. Usually it is a benign disease
in the baby including preterm labor. follow it.
but it may cause malformations in the

embryo in pregnant women. Wikipedia
in Jul 2012.
!

c. Local
Anesthetics
Pregnancy

and A n e s t h e t i c s
vasoconstrictor

Measles is a disease caused by

the measles virus and transmitted by the A n e s t h e t i c s
airways. Generally there is resolution

without

vasoconstrictors

It is not recommended the

one of the most frequent causes of death use

of

anesthetics

without

in children in many regions, mainly in vasoconstrictors for their duration is

anterior part) and may be used in the acetaminophen,
sacral hiatus (epidural sacral block), in bitartrate

bitartrate

with

hydrocodone ibuprofen - Analgesic association to

with

the cervical, lumbar or thoracic regions. oxycodone

with Hydrocodone

ibuprofen

with

and relieve moderate pain. www.msd-

acetaminophen brazil.com in Jul 2012.

It can also be used as local anesthetic by may produce neonatal respiratory Oxycodone with acetaminophen infiltration, loco-regional, dental block depression (Acetyl Salicylic Acid Analgesic
and

sympathetic

nerve

block. analgesic,

antithermic

Mepivacaine is a drug that blocks the inflammatory

with

and

association

to

relieve

anti- moderate pain.www.msd-brazil.com

antithrombotic in Jul 2012.

nerve conduction activity preventing the action. Do not use in surgical post-op. About antibiotics, it is known that
start and propagation of nerve impulse. Digital Dictionary of Medical Terms in chloramphenicol is a high risk drug
It is the ability to act as local anesthetic. www.pdamed.com.br in Jul 2012.
Bradycardia - Decrease in cardiac rate. Ibuprofen

-

Non-steroidal

In the human being the normal cardiac inflammatory

drugs

for the mother and the fetus and
anti- may cause Gray Syndrome with fetal

(NSAIDs) death due to its highly toxic action.

rate is between 60 and 100 heartbeats frequently used to relieve the symptoms Doxycycline
per

minute.

Rates

below

60

may

cause

dental

are in headaches (migraines), toothaches, discoloration and inhibition of bone

bradycardia. Bradycardia may cause low muscle pain (myalgia), menstruation growth. Erythromycin estolate may
pressure due to the decrease in the disorders (dysmenorrheas), fever and cause reduction or interruption of
cardiac muscle effort. Bradycardia may post-surgery pain. It is also used to treat the maternal biliary flow (hepatic
cause damages to the body due to less inflammations,

such

as

arthritis, cholestasis). Gentamicin is ototoxic

blood circulation that transports less reumatoid arthritis (RA) and gout to the fetus. Antibiotic therapy is not
oxygen to the cells. Wikipedia in Jul arthritis. Digital Dictionary of Medical recommended
2012

and

ANVISA

tetracycline-

i n Terms in http://www.pdamed.com.br in based drugs as they may cause

and low calcium binding. retardation of the female fertility (which we are naturally subjected to
www.gross.com.br in Jul 2012.
Erythromycin
Bacteriostatic.

(Anxiolytics and Benzodiazepines- during a normal day), the irradiation

estolate
Against

- Drugs with the property of acting on of a radiograph is 5 times less.

spirochetes anxiety and stress. Also used to treat Mandatory biosafety measures must

(treponema and leptospira), rickettsia, insomnia, being also called hypnotic be taken into account, such as
campylobacter, mycoplasma, ureaplasma drugs, that is, drugs that induce wearing a lead apron in the patient,
(urethritis),

legionella,

chlamydia, sleep. www.unifesp.br in Jul 2012.

covering the thyroid, adequate room

gardnerella, actinomycetes and cholera. Nitrous oxide -- Given together with and the necessary amount of X-rays
Moderate action against anaerobes but Oxygen,

it

has

analgesic

and to

provide

an

efficient

dental

Bacteroides fragilis is resistant. Gram- sedative effect. In general anesthesia, treatment.
negative from the enterobacteria and the addition of nitrous oxide to If there is need of a minor oral
pseudomona group are resistant to oxygen allows a reduction in the surgery (for example, extraction of a
erithromycin. It has been observed the most expensive anesthetic agent, third
resistance

of

S.

aureus

and

molar),

two

periapical

S. obtaining the same effect. Wikipedia radiographs and one occlusal can be

Radiographic
infections. It is efficient against many
(X-rays)
gram-negative

that

the

mother and the baby. Care should be

used in the treatment of bacterial

species,

whenever

and

the working length and one final
with the filling material that is
important to posterior control of the
therapy success. These 3 X-rays are
the minimum for a good endodontic
treatment.

The

prenatal

doctor

should know about the necessary Xrays and that proper care will be

Examinations taken as to biosafety.

gram-

X-rays are detrimental to
some !
e. Oral Problems in pregnancy
health
if
used
indiscriminately
in
protozoans. Wikipedia in Nov 2012).
Caries
!
Anxiolytics
a n d excessive irradiation amounts. In the
!
The highest incidence in this
benzodiazepines under prolonged morning, when you stay in the sun
period (99.38% of pregnant women intake may be associated to palatal at a Brazilian beach you are much
Paula e Silva et al. 2006) is related to
clefts. Nitrous oxide used in more exposed to noxious irradiation
the intake of cariogenic food
conscious sedation may be related to than taking an X-ray.
positive

this period (99.38% of tumefaction. The first and most proliferative lesion that is more
pregnant women - Paula e Silva et al. effective treatment to this problem is commonly located in the gingiva at
2006) is related to the intake of brushing associated to the use of the anterior region of the maxilla.
cariogenic

food

frequently dental floss, as the stimulus is the Clinically it is a slow growth nodular

(carbohydrates in sweetened juices increase in the amount of bacterial mass, reddish, soft to palpation and
and soft drinks and sweets) and also plaque.
the

decreased

secretion

and !

prone to spontaneous hemorrhage.

A more severe scenario of Treatment

consists

of

surgical

alteration in the saliva composition gingivitis that usually occurs from removal and elimination of any local
that characterizes the gestational the 3rd. month on is the so called factor that may irritate and cause
period

(reduction

in

the

buffer pyogenic granuloma that looks like relapse of the lesion, although it is

capacity - Paula e Silva et al. 2006). mulberry
Caries

is

prevented

if

for

the

granular reported

that

it

may

recede

you appearance and the dark red color spontaneously after the baby is born.

recommend no sugar in milk or (depending on the hormonal conditions Surgical removal is indicated only in
juices or by replacing the sugar for of the pregnant woman, it is an the first months of pregnancy and if
artificial sweeteners when necessary. inflammatory response to the bacterial it impairs correct feeding, affects
The installed caries should be treated plaque; usually it shows up after the esthetics or teeth maintenance in the
as soon as possible following the third month pregnancy as a flat mass oral cavity, but it may relapse if done
criteria addressed here (anesthetics â&#x20AC;&#x201C; protruding from the interproximal space before

delivery.

radiographs) so that the problem or gingival margin. It is dark red, a recommended

Removal

is

labor

(if

post

may not progress and root canal has bright and smooth surface with many possible) if there is no risk of losing
to be done.

connective tissue with many neoformed disease may be related to low weight

Brushing and the use of capillaries, with edema and chronic at

birth

demanding

a

guided

dental floss (link to the respective inflammatory infiltrate; it is a superficial treatment and detailed evaluation of
texts) should be performed carefully lesion that does not invade subjacent oral hygiene in the patients (Paula e
during all the gestational period and bone and generally produces no pain. Silva et al. 2006).
during the whole life of the patient. www.odontologia.com.br in Jul 2012).
Eating

cariogenic

food

more !

!

Dental caries is a disease that

Paula e Silva et al. (2006) affects deciduous and permanent

frequently increases the potential to observed that this pathology attacks teeth. It is characterized by the attack
develop caries (link to the respective 1 to 5% of pregnant women and of

acidogenic

bacteria

that

text) and periodontal disease (link to occurs due to the angiogenesis demineralize the enamel and dentin
the respective text). If this is added increased by the plasmatic levels of surfaces causing hard tissue loss and
to hormonal alterations, it is possible elevated estrogens associated to local inflammation followed by pulpal
to see an unpleasant gingivitis with irritation (trauma, biofilm and dental death (fig. 5). Restorative treatment
UPDATING OF THE BASIC ORAL CARE NOTEBOOK 2012 - FOUSP - Ministry of Health

8

O

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A

L

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H

I

N

in the beginning of the disease may hold its !

P

R

E

G

N

A

N

C

Y

These bacteria proliferate, attach to the dental

progression; that is why one should see the surface and get their nutrients (substrates) from the food
dentist each 6 months.

remnants stuck to the teeth’s surface.
!

The installation of dental biofilm in individuals

with poor oral hygiene causes inflammation in the
supporting tissues of teeth, characterized by swelling,
redness and bleeding in this initial phase (gingivitis –
fig. 6).

a

b
Figura 6 - Gingivitis

!

If the problem is not immediately treated this

condition evolves to severe inflammation (periodontal
disease or periodontitis) and can turn into tooth loss
due to the absence of bone attachment (inflammation of
all supporting tissues – figs. 7 and 8).

accumulation in the surface of teeth. Dental biofilm is
characterized by a bacterial population that interacts to
produce tooth enamel decalcification and/or may
calcify and produce dental calculus around teeth
(Biofilm is a microbial consortium included in the ECP mass
(extracellular

the palatal aspects of the upper teeth. The patient. JADA, 129, p.1281- 1286, Sept 1998.
patient must learn how to use dentifrices and oral
mouth rinses with fluoride so that enamel can Paula

e

Silva

FWG,

Stuani

AS,

Queiroz

AM

remineralize as soon as possible, preventing caries Atendimento Odontológico à Gestante - Parte 1:
caused by the development of cavities associated to the Alterações Sistêmicas Rev Fac Odontol Porto Alegre, 47
other alterations that are seen in the gestational period.